|
ICU Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
||||||
| Rating Stars (Click) | Cardiac | 1 | 2 | 3 | 4 | ||
 |
Defibrillation/Cardioversion | ||||||
|
|
Assisting with Insertion of Central Lines | ||||||
|
|
Pacemakers‐External | ||||||
|
|
Permanent or Temporary Pacemaker | ||||||
|
|
Cardiac Arrest/CPR | ||||||
|
|
A‐Line (Transducer setup‐D/C) | ||||||
|
|
Swan Ganz (Transducer setup‐D/C) | ||||||
|
|
Balloon Pump (IABP) | ||||||
|
|
SVO2 Monitoring | ||||||
|
|
Automatic Internal Cardioverter Defib | ||||||
| Rating Stars (Click) | Care of patient with | 1 | 2 | 3 | 4 | ||
|
|
Aneurysm | ||||||
|
|
Acute MI/Unstable Angina | ||||||
|
|
Cardiogenic/Hypovolemic Shock | ||||||
|
|
Pre/Post Cardiac Surgery | ||||||
|
|
Heart Transplant | ||||||
|
|
PTCA | ||||||
|
|
COPD | ||||||
|
|
ARDS | ||||||
|
|
Pulmonary Embolism | ||||||
|
|
Pulmonary Edema | ||||||
|
|
Pneumonia | ||||||
|
|
Inhalation Injuries | ||||||
|
|
CVA | ||||||
|
|
Seizure Disorder | ||||||
|
|
Overdose | ||||||
|
|
Neuro Injury/Trauma | ||||||
|
|
Pre/Post Neuro Surgery | ||||||
|
|
Cranial Hemorrhage | ||||||
|
|
Aphasia | ||||||
|
|
Multiple Sclerosis | ||||||
|
|
Pancreatitis | ||||||
|
|
GI Bleed | ||||||
|
|
Esophageal Bleeding | ||||||
|
|
Bowel Obstruction | ||||||
|
|
Liver Transplant | ||||||
|
|
Paralitic Ileus | ||||||
|
|
TURP | ||||||
|
|
Shunts and Fistulas | ||||||
|
|
Nephrectomy | ||||||
|
|
Renal Transplant | ||||||
|
|
Renal Trauma | ||||||
| Rating Stars (Click) | Use and Administration of the following | 1 | 2 | 3 | 4 | ||
|
|
Atropine | ||||||
|
|
Bretylol | ||||||
|
|
Bumex | ||||||
|
|
Digoxin | ||||||
|
|
Dopamine | ||||||
|
|
Dobutrex | ||||||
|
|
Inderal | ||||||
|
|
Inocor | ||||||
|
|
Isuprel | ||||||
|
|
Lidocaine | ||||||
|
|
Neosynephrine/Nipride | ||||||
|
|
NTG | ||||||
|
|
Pronestyl | ||||||
|
|
Titrate Morphine | ||||||
|
|
Verapamil | ||||||
|
|
Thrombolitic Agents | ||||||
|
|
Prep/Titration of Emergency Drugs | ||||||
|
|
Aminophylline | ||||||
|
|
Corticosteroids | ||||||
|
|
Bronkosol | ||||||
|
|
Ventolin | ||||||
|
|
Alupent | ||||||
|
|
Decadron | ||||||
|
|
Dilantin | ||||||
|
|
Magnesium Sulfate | ||||||
|
|
Phenobarbital | ||||||
|
|
Steroids | ||||||
|
|
Valium | ||||||
|
|
Versed | ||||||
| Rating Stars (Click) | Respiratory | 1 | 2 | 3 | 4 | ||
|
|
Lung Transplant | ||||||
|
|
Establishing an Airway | ||||||
|
|
Pulse Oximetry | ||||||
|
|
Interpretation of ABG | ||||||
|
|
Drawing ABG Blood Sample from A‐Line | ||||||
|
|
Incentive Spirometer | ||||||
| Rating Stars (Click) | Neurology | 1 | 2 | 3 | 4 | ||
|
|
Assessment of Neuro Signs | ||||||
|
|
Use of Glascow Coma Scale | ||||||
|
|
Seizure Precautions | ||||||
|
|
Assist with Lumbar Puncture | ||||||
|
|
ICP Monitoring | ||||||
|
|
Crutchfield Tongs | ||||||
|
|
Halo Traction | ||||||
|
|
Stryker Frame | ||||||
|
|
Assessment of Sensory‐Motor Function | ||||||
|
|
Cervical Traction | ||||||
|
|
Cranial Nerve Assessment | ||||||
|
|
LOC Assessment | ||||||
|
|
Pre/Post Neuro Surgical Care | ||||||
|
|
Visual Acuity Measurement | ||||||
| Rating Stars (Click) | Vascular | 1 | 2 | 3 | 4 | ||
|
|
Peripheral Pulses | ||||||
|
|
Fluid Overload | ||||||
|
|
Starting IV's | ||||||
|
|
Subcutaneous Central Line | ||||||
|
|
Hickman/Broviac/Groshong Catheters | ||||||
|
|
Mainenance of Heparin Lock | ||||||
|
|
TPN/Hyperalimentation | ||||||
|
|
Air Occlusive Dressing | ||||||
|
|
Infusion Pump | ||||||
|
|
Peritoneal Dialysis | ||||||
|
|
Hemodialysis | ||||||
|
|
Heparin Drip ‐ Precautions and Maintenance | ||||||
| Rating Stars (Click) | Gastrointestinal | 1 | 2 | 3 | 4 | ||
|
|
NG Tube Insertion | ||||||
|
|
Gastronomy Tube | ||||||
|
|
Jejunoostomy Tube | ||||||
|
|
Enterostomal Care | ||||||
| Rating Stars (Click) | Genito Urinary/Renal | 1 | 2 | 3 | 4 | ||
|
|
Foley Catheter Insertion | ||||||
|
|
GU Irrigations | ||||||
|
|
Nephrostomy Tube | ||||||
|
|
Suprapubic Tube | ||||||
|
|
Electrolyte Imbalance/Replacement | ||||||
| Rating Stars (Click) | Other | 1 | 2 | 3 | 4 | ||
|
|
Oncology | ||||||
|
|
Chemotherapy | ||||||
|
|
Isolation Techniques | ||||||
|
|
Hyperbaric Oxygenation | ||||||
|
|
Fingerstick Blood Glucose monitoring | ||||||
| Rating Stars (Click) | Equipment | 1 | 2 | 3 | 4 | ||
|
|
Bear I | ||||||
|
|
Bear II | ||||||
|
|
Bear V | ||||||
|
|
Bennett 7200 | ||||||
|
|
CPAP | ||||||
|
|
Emerson | ||||||
|
|
EMV | ||||||
|
|
MA‐I | ||||||
|
|
MA‐II | ||||||
|
|
Monihan | ||||||
|
|
Ohio 560 | ||||||
|
|
PEEP | ||||||
|
|
Pressure Pre‐Set | ||||||
|
|
Servo 900b | ||||||
|
|
Servo 900c | ||||||
|
|
Servo 900e | ||||||
|
|
Siemens | ||||||
|
|
Hewlett‐Packard | ||||||
|
|
Spacelab | ||||||
|
|
Marquette | ||||||
|
|
Mennen | ||||||
|
|
Lifecare | ||||||
|
|
Nihon‐Koder | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
|
|
Infant (Birth - 1 year) | ||||||
|
|
Preschooler (ages 2-5 years) | ||||||
|
|
Childhood (ages 6-12 years) | ||||||
|
|
Adolescents (ages 13-21 years) | ||||||
|
|
Young Adults (ages 22-39 years) | ||||||
|
|
Adults (ages 40-64 years) | ||||||
|
|
Older Adults (ages 65-79 years) | ||||||
|
|
Elderly (ages 80+ years) | ||||||